title: Comparison of two editions of Tokyo guidelines for the management of acute cholangitis.
abstract: BACKGROUND
  The Tokyo guidelines from 2007 (TG07) and 2013 (TG13) were compared for the management of acute cholangitis (AC).
  
  
  METHODS
  We reviewed patients with clinically-proven AC by detecting purulent biles during biliary drainage. TG07 and TG13 were compared regarding diagnosis, severity grading and prognostic values. New risk factors for 30-day mortality were investigated.
  
  
  RESULTS
  Definite diagnosis for 120 eligible patients was made in 104 (86.7%) and 101 (84.2%) cases by TG07 and TG13, respectively (P = 0.36), higher than 61 (50.8%) by Charcot's triad (P < 0.001). Diagnostic overlap and concordance (κ) are 90.8% (109/120) and 0.63 (P < 0.0001). Patients classified into mild and moderate grades by TG07 and TG13 differed significantly (P = 0.043). Both guidelines could not predict clinical outcomes except the needs for multi ERCP session by TG13. Intrahepatic obstruction (OR = 11.2, 95% CI: 1.55-226.9) and hypoalbuminemia (≤ 25.0 g/l; OR = 17.3, 95% CI: 3.5-313.6) were independent risk factors for 30-day mortality in multivariate model.
  
  
  CONCLUSIONS
  Two guidelines are reproducible and reliable in AC diagnosis but different in severity grading. TG13 are more practical for immediate severity grading, enabling planning treatment upon admission. Intrahepatic obstruction is a new candidate predictor of 30-day mortality for further assessment.
authors.affiliation: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Sun
authors.forename: Lu
authors.initials: L
authors.lastname: Han
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Yang
authors.forename: Enqiang
authors.initials: E
authors.lastname: Linghu
authors.forename: Wen
authors.initials: W
authors.lastname: Li
authors.forename: Fengchun
authors.initials: F
authors.lastname: Cai
authors.forename: Jinyan
authors.initials: J
authors.lastname: Kong
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Wang
authors.forename: Jiangyun
authors.initials: J
authors.lastname: Meng
authors.forename: Hong
authors.initials: H
authors.lastname: Du
authors.forename: Hongbin
authors.initials: H
authors.lastname: Wang
authors.forename: Qiyang
authors.initials: Q
authors.lastname: Huang
authors.forename: Quratulain
authors.initials: Q
authors.lastname: Hyder
authors.forename: Xiuli
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D002761:Cholangitis / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D014041:Tokyo
keywords: Acute cholangitis; Biliary drainage; Interrater agreement; Tokyo guidelines